Implementing End-to-End Process Controls To Assure HIPAA 5010 Compliance

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Implementing End-to-End Process Controls To Assure HIPAA 5010 Compliance"

Transcription

1 Implementing End-to-End Process Controls To Assure HIPAA 5010 Compliance Executive Summary Client: Health Insurance Payer Industry: Healthcare Insurance Challenges: Compliance mandates were costly to achieve Fines due to insufficient audit documentation Missing transaction acknowledgements Poor error detection and reconciliation Solutions: The Infogix Controls Solution Results: Real-time monitoring and tracking of claim transactions Reduced the processing of invalid and duplicate claims Addressed audit requirements to account for all submitted claims Reduced time and cost to detect and account for EDI transactions Increased profit margins for certain classes of claims Infogix Reduced Costs, Improved Visibility and Grew Profit Margins with Real-time Controls for Leading Insurance Payer With over 13 million members, this major insurer spans multiple lines of business across several subsidiaries. It offers healthcare medical plans that include HMO, PPO, dental, supplemental Medicare, indemnity, pointof-service (POS), and group life and disability insurance. Its members span across employers, Medicare recipients, government, and individual consumers in the U.S. As the largest customer-owned and one of the top five healthcare insurers in the U.S., the insurer s Electronic Data Interchange (EDI) transmissions are critical to effectively managing processes across claims adjudication, membership, enrollment and payment processing. The insurer processes about 176 million claims a year, with an average of $160 million paid in claims per day. To comply with transition to HIPAA 5010 to drive administrative simplification and transparency, the insurer implemented vendor specific solutions and processes to exchange health information between its clearinghouses, providers and other service vendors. Transitioning from HIPAA 4010 to 5010 required a new coding set that allowed for more specific classification of healthcare services. Designed to decrease the need for supporting documentation of claims, the overarching goal was to streamline claims processing with more precise pricing, fewer claims rejects and reduced administrative expenses. The transition has not been without its challenges, however, and it has meant a significant financial investment for providers and insurers.

2 For this insurance payer, compliance mandates had hindered operational efficiency and drained substantial amounts of capital from its businesses. Explosive growth in the volume of transactions, the aggressive transition to HIPAA 5010, and the integration of new systems and decommissioning of some legacy systems led to associated risks with EDI transmissions. For this insurance payer, compliance mandates hindered operational efficiency and drained substantial amounts of capital from its businesses. Explosive growth in the volume of transactions, the aggressive transition to HIPAA 5010, and the integration of new systems and the decommissioning of some legacy systems led to associated risks with EDI transmissions. The Challenge Each day, the insurer receives millions of EDI transactions from healthcare clearinghouses and providers. Transactions come in as batch files where they were validated and transformed into individual transactions. The claims transactions then passed through complex sets of processes and systems for adjudication. Concerns included: Operational Risks: delayed adjudications, missing claims and duplicate submissions Transmission Risks: inconsistent acknowledgements and invalid file formats Compliance Risks: lack of historical documentation for audit and compliance The insurer translated each large file into flat files with multiple records for use in its claim payment process, integrating with clearinghouses and vendor EDI packages. The insurer was required to send timely claims received (A0) and claims accepted (A1) responses to its trading partners. The high volume of EDI transactions made it virtually impossible to manually reconcile transactions as they moved from one system to another. Moreover, the insurer missed certain acknowledgements to its clearinghouses and was unable to detect and correct errors in a timely fashion. With regards to claims process, the insurer was often unable to account for missing claims. The process of identifying lost claims was daunting, and the insurer could not afford to slow down the claims process to remedy the situation. Additionally, the insurer did not have sufficient documentation to account for historical claim information to satisfy internal audit and the National Association of Insurance Commissioner s Model Audit Rule (NAIC-MAR), resulting in fines. The insurer turned to Infogix for assistance, and it was decided that the Infogix Controls Solution would provide the needed control, support and visibility.

3 The Solution Infogix identified a list of the key processing points across the insurer s claims workflows that have significant data transformations and system boundary handoffs. The Infogix Controls Solution was deployed at these control points, as denoted by tick and equals symbols in Figure 1. The Multi-Step Claims Flow (Figure 1) Claims Process Flow Pre-Process Core Process Adjudication Routing Claims IN (PP1) (PP8) (PP15) (PP22) (PP2) (PP3) (PP9) (PP10) (PP16) (PP17) (PP23) (PP24) (PP4) (PP11) (PP18) (PP25 (PP5) (PP6) (PP12) (PP13) (PP19) (PP20) (PP26) (PP27) (PP7) (PP14) (PP21) (PP28) Claims OUT Figure 2: Infogix Control s across Claim Workflow Infogix deployed nine control points within the multi-step process. The Infogix Controls Solution provided capabilities that included: Control Detecting empty files and timeliness of incoming batches Detecting incomplete, duplicate and inaccurate transmissions Determining and reporting claim counts by clearinghouses and vendors Analyzing batches and out-of-sequence batches for potentially missing EDI transactions Visibility Tracking and monitoring the claims flow across key processing points in near real-time (see Figure 2) Detecting and accounting for missing claims during claims processing Monitoring timeliness of acknowledgments and reporting on missing responses

4 Analytics Measuring provider performance by percentage of incomplete claim information submitted Developing metrics for incorrect EDI transmissions to measure performance of trading partners Generating sophisticated management reporting Generating claim audit data as it happens (Figure 2) Sample Claim Audit Trail Report (Figure 2) Pre-Process Pre-Adjudication Process Core Adjudication Process Routing Process Claim Lifecycle Claim ID Claim Type Location Time Stamp Location Time Stamp Location Time Stamp Location Time Stamp Location Time Stamp Location Time Stamp Location Time Stamp Location Time Stamp Location Time Stamp Complete? CL20001 P 07:45:01 AM 07:56:05 AM 07:58:01 AM 08:01:21 AM 08:01:50 AM 08:05:01 AM 08:06:21 AM 08:07:49 AM Yes CL20004 I 07:51:01 AM 07:56:05 AM No PP8 CL20005 CL20006 I P 07:51:01 AM 07:45:01 AM 07:57:05 AM 07:56:05 AM 07:59:11 AM 07:58:01 AM 08:02:31 AM 08:01:21 AM 08:03:50 AM 08:10:01 AM 08:11:21 AM 08:11:49 AM Yes 08:01:50 AM No PP17 Figure 3: Claim Audit Trail Report This sample audit trail report shows how the Infogix Controls Solution provides real-time visibility into a highly complex claims processing system. The Results The Infogix Controls Solution delivered the insurer significant savings in time and costs associated with claim processing and analysis. The solutions help detect errors earlier in the workflow, before they become bottlenecks to downstream systems, and ultimately improve service level agreements (SLAs), especially for high priority claims. The insurer has been able to effectively utilize the Infogix Controls Solution to: Monitor and track claim transactions Reduce the processing of invalid and duplicate claims Successfully address audit requirements to account for all claims that are submitted to its gateway Significantly reduce the time and costs to detect and account for EDI transactions Increase profit margins for certain classes of claims Save more than 30% of internal audit cost related to NAIC-MAR Infogix also helped the insurer to eliminate errors that threatened its reputation as a low cost and consistent service provider.

5 The insurer has significantly reduced time and money while increasing its profit margins for certain classes of claims. It further saved more than 30% of its internal audit costs related to NAIC- MAR. The Infogix Advantage Infogix is a pioneer of automated data integrity controls and predictive analytics which enable the world s leading enterprises to operate efficiently, minimize risk, maximize revenue and manage the customer lifecycle. With over 30 years of industry knowledge in multiple verticals, we take a collaborative, partnership approach to every customer relationship to create a shared vision for mutual success. Infogix solutions easily and nonintrusively integrate into your everyday operations and have a proven history of delivering a rapid return on investment. For more information, call (U.S., Canada, and International), or visit Learn how Infogix Controls can save you time and money. Visit or call (US, Canada. and International), (UK and Europe). twitter.com/infogix facebook.com/infogix linkedin.com/company/infogix plus.google.com/+infogix Copyright 2014 Infogix, Inc. All rights reserved. Company, product, brand, and mark names and logos herein are the property of their respective owners. For a list of Infogix trademarks, visit:

Introduction. By Santhosh Patil, Infogix Inc.

Introduction. By Santhosh Patil, Infogix Inc. Enterprise Health Information Management Framework: Charting the path to bring efficiency in business operations and reduce administrative costs for healthcare payer organizations. By Santhosh Patil, Infogix

More information

EDI Solutions Your guide to getting started -- and ensuring smooth transactions empireblue.com/edi

EDI Solutions Your guide to getting started -- and ensuring smooth transactions empireblue.com/edi EDI Solutions Your guide to getting started -- and ensuring smooth transactions empireblue.com/edi 00175NYPEN Rev. 12/11 This brochure is a helpful EDI reference for both new and experienced electronic

More information

EDI Solutions Your guide to getting started -- and ensuring smooth transactions anthem.com/edi

EDI Solutions Your guide to getting started -- and ensuring smooth transactions anthem.com/edi EDI Solutions Your guide to getting started -- and ensuring smooth transactions anthem.com/edi 00175CEPEN (04/12) This brochure is a helpful EDI reference for both new and experienced electronic submitters.

More information

EDI Solutions Your guide to getting started -- and ensuring smooth transactions bcbsga.com/edi

EDI Solutions Your guide to getting started -- and ensuring smooth transactions bcbsga.com/edi EDI Solutions Your guide to getting started -- and ensuring smooth transactions 00175GAPENBGA Rev. 12/11 This brochure is a helpful EDI reference for both new and experienced electronic submitters. It

More information

ICD-10: Business Continuity Contingency Plans. Presenter: D. Keith Hatch, Florida Blue, Consultant, EDI Operational Assessment

ICD-10: Business Continuity Contingency Plans. Presenter: D. Keith Hatch, Florida Blue, Consultant, EDI Operational Assessment ICD-10: Business Continuity Contingency Plans Presenter: D. Keith Hatch, Florida Blue, Consultant, EDI Operational Assessment Presentation Content Purpose Provide an overview of activities to ensure operational

More information

POWERFUL CHANNEL PARTNER SOLUTIONS

POWERFUL CHANNEL PARTNER SOLUTIONS POWERFUL CHANNEL PARTNER SOLUTIONS Simplifying the Business of Healthcare ONE PARTNER CAN HELP YOU OFFER YOUR CLIENTS MORE COMPLETE REVENUE CYCLE SOLUTIONS... ENHANCE YOUR PARTNERSHIPS TABLE OF CONTENTS

More information

REVENUE CYCLE CLARITY. Streamlined Solutions for Hospitals and Physicians

REVENUE CYCLE CLARITY. Streamlined Solutions for Hospitals and Physicians REVENUE CYCLE CLARITY Streamlined Solutions for Hospitals and Physicians SOLUTIONS for Hospitals and Large Physician Groups ClaimLogic offers a full suite of advanced claims and payment processing systems

More information

The benefits of electronic claims submission improve practice efficiencies

The benefits of electronic claims submission improve practice efficiencies The benefits of electronic claims submission improve practice efficiencies Electronic claims submission vs. manual claims submission An electronic claim is a paperless patient claim form generated by computer

More information

DY574_261023_br. OMPP MMIS HIPAA 5010 /Edifecs Project. Overview

DY574_261023_br. OMPP MMIS HIPAA 5010 /Edifecs Project. Overview OMPP MMIS HIPAA 5010 /Edifecs Project HIPAA 5010/Edifecs Project Implementation HIPAA 5010/Edifecs Project Implementation Overview Project purpose Comply with CMS HIPAA 5010/D.0 EDI standard The Centers

More information

Real Time Adjudication

Real Time Adjudication Real Time Adjudication THE HOLY GRAIL or NOT? Market Trends AMA 2009 Cost Survey Report With 2008 Data 9.9% fewer procedures Nunber of patients dropped 11.3% Multi-specialty practices bad debts increased

More information

WHITE PAPER GROW REVENUE WITH HEALTHCARE LOCKBOX SERVICES

WHITE PAPER GROW REVENUE WITH HEALTHCARE LOCKBOX SERVICES WHITE PAPER GROW REVENUE WITH HEALTHCARE LOCKBOX SERVICES 2013 WAUSAU FINANCIAL SYSTEMS, INC. All Rights Reserved. All other copyrights cited herein are the property of their respective owners. TABLE OF

More information

Understanding the HIPAA standard transactions: The HIPAA Transactions and Code Set rule

Understanding the HIPAA standard transactions: The HIPAA Transactions and Code Set rule Understanding the HIPAA standard transactions: The HIPAA Transactions and Code Set rule Many physician practices recognize the Health Information Portability and Accountability Act (HIPAA) as both a patient

More information

Compliance Management EFFECTIVE MULTI-CUSTODIAL COMPLIANCE AND SALES SURVEILLANCE

Compliance Management EFFECTIVE MULTI-CUSTODIAL COMPLIANCE AND SALES SURVEILLANCE Compliance Management EFFECTIVE MULTI-CUSTODIAL COMPLIANCE AND SALES SURVEILLANCE Broker-dealers that have implemented best practices consistently report that they have increased confidence in their ability

More information

Electronic data interchange and proactive services for customers using revenue cycle management solutions from the Centricity portfolio

Electronic data interchange and proactive services for customers using revenue cycle management solutions from the Centricity portfolio GE Healthcare Electronic data interchange and proactive services for customers using revenue cycle management solutions from the Centricity portfolio imagination at work Accelerate revenue cycle performance

More information

DEPARTMENT OF TRANSPORT SOUTH AFRICA

DEPARTMENT OF TRANSPORT SOUTH AFRICA DEPARTMENT OF TRANSPORT SOUTH AFRICA EMC solutions speed workflows, transform processes, and elevate service levels OVERVIEW The Department of Transport oversees all modes of transportation throughout

More information

Enhance visibility into and control over software projects IBM Rational change and release management software

Enhance visibility into and control over software projects IBM Rational change and release management software Enhance visibility into and control over software projects IBM Rational change and release management software Accelerating the software delivery lifecycle Faster delivery of high-quality software Software

More information

MEDICAL CLAIMS AND ENCOUNTER PROCESSING

MEDICAL CLAIMS AND ENCOUNTER PROCESSING MEDICAL CLAIMS AND ENCOUNTER PROCESSING February, 2014 John Williford Senior Director Health Plan Operations 2 Medical Claims and Encounter Processing Medical claims and encounter processing is part of

More information

HIPAA COW Spring 2012 HIPAA 5010. Provider 5010 Claim Experience. Quick Identification + Quick Notification = Quick Resolutions

HIPAA COW Spring 2012 HIPAA 5010. Provider 5010 Claim Experience. Quick Identification + Quick Notification = Quick Resolutions HIPAA COW Spring 2012 5010 Highlights and Updates Christol Green Sr. EDI Business Consultant christol.green@anthem.com HIPAA 5010 Provider 5010 Claim Experience Anthem 5010 Experience Escalating 5010 Questions

More information

835 Health Care Claim Payment/Advice Companion Guide

835 Health Care Claim Payment/Advice Companion Guide 835 Health Care Claim Payment/Advice Companion Guide HIPAA/V5010X221A1/835 Version: 1.2 Company: Blue Cross of Idaho Created: 07/18/2014 1.1 Disclaimer Blue Cross of Idaho (BCI) created this Companion

More information

HIPAA Life Cycle and Project Plan A roadmap to becoming Compliant with HIPAA Transactions and Code Sets

HIPAA Life Cycle and Project Plan A roadmap to becoming Compliant with HIPAA Transactions and Code Sets HIPAA Life Cycle and Project Plan A roadmap to becoming Compliant with HIPAA Transactions and Code Sets Model Compliance Plan for Extension and Project Plan The Centers for Medicare & Medicaid Services

More information

Claims Modernization for the Reform Era. Elizabeth Hart, Healthcare Principal, Pegasystems Terry Weber, Healthcare Executive, Pegasystems

Claims Modernization for the Reform Era. Elizabeth Hart, Healthcare Principal, Pegasystems Terry Weber, Healthcare Executive, Pegasystems Claims Modernization for the Reform Era Elizabeth Hart, Healthcare Principal, Pegasystems Terry Weber, Healthcare Executive, Pegasystems March 30, 2011 Speaker Introduction Elizabeth Hart 25 years in Healthcare

More information

IBM Tivoli Netcool network management solutions for enterprise

IBM Tivoli Netcool network management solutions for enterprise IBM Netcool network management solutions for enterprise The big picture view that focuses on optimizing complex enterprise environments Highlights Enhance network functions in support of business goals

More information

Empowering healthcare organizations with data, analytics and insight

Empowering healthcare organizations with data, analytics and insight Empowering healthcare organizations with data, analytics and insight Integrated patient access, claims and contract management and collections products and consultative services for redefining your healthcare

More information

Electronic data interchange and proactive services for Centricity revenue cycle management customers

Electronic data interchange and proactive services for Centricity revenue cycle management customers GE Healthcare Electronic data interchange and proactive services for Centricity revenue cycle management customers Accelerate revenue perf Key features Tight alignment with payers ensures mandates, updates

More information

Part of the Deloitte working capital series. Make your working capital work for you. Strategies for optimizing your accounts payable

Part of the Deloitte working capital series. Make your working capital work for you. Strategies for optimizing your accounts payable Part of the Deloitte working capital series Make your working capital work for you Strategies for optimizing your accounts payable The Deloitte working capital series Strategies for optimizing your accounts

More information

SAP Solution Overview: SAP Cloud for Travel and Expense An Easier Way to Travel

SAP Solution Overview: SAP Cloud for Travel and Expense An Easier Way to Travel : An Easier Way to Travel Table of Contents Overview...1 Solutions... 2 Benefits... 8 Quick Facts... 11 1 Overview: Focus on your business while controlling travel costs. With the increasing cost of business

More information

The Connected Customer Engagement Lifecycle

The Connected Customer Engagement Lifecycle The Connected Customer Engagement Lifecycle Chris Bates VP of Global Customer Success Clarizen Copyright 2015 Clarizen@Work. All rights reserved v www.clarizen.com Work in the Past Copyright 2015 Clarizen@Work.

More information

Four keys to effectively monitor and control secure file transfer

Four keys to effectively monitor and control secure file transfer Four keys to effectively monitor and control secure file transfer Contents: 1 Executive summary 2 Key #1 Make your data visible wherever it is in the network 2 Key #2 Reduce or even eliminate ad hoc use

More information

Informatica Master Data Management

Informatica Master Data Management Informatica Master Data Management Improve Operations and Decision Making with Consolidated and Reliable Business-Critical Data brochure The Costs of Inconsistency Today, businesses are handling more data,

More information

5 Five Ways to Fast ROI With Business Rule Management Systems (BRMS)

5 Five Ways to Fast ROI With Business Rule Management Systems (BRMS) Cost Reduction Why Business Rules? Why Now? 5 Five Ways to Fast ROI With Business Rule Management Systems (BRMS) Five Ways to Fast ROI With BRMS Business becomes increasingly complex with each passing

More information

Best In Class Payer EDI Operations for a Single Source of Claim Truth

Best In Class Payer EDI Operations for a Single Source of Claim Truth Best In Class Payer EDI Operations for a Single Source of Claim Truth Edifecs Strategic Advisory Services What are the current Market Drivers Current trends within the industry Administrative Cost Savings

More information

Technology and Expertise Add Operational Value to Medical Device Trials

Technology and Expertise Add Operational Value to Medical Device Trials Technology and Expertise Add Operational Value to Medical Device Trials Copyright 2015 Medidata Solutions. Medidata Solutions and other trademarks reserved in the US and globally. Medidata and other marks

More information

Mobile Workflow Solutions: Better, Faster and More Profitable Business For You and Your Customers

Mobile Workflow Solutions: Better, Faster and More Profitable Business For You and Your Customers Mobile Workflow Solutions: Better, Faster and More Profitable Business For You and Your Customers Contents EXECUTIVE SUMMARY 2 INTRODUCTION WHAT IS A MOBILE WORKFLOW SOLUTION? 2 THE BENEFITS OF MOBILE

More information

ICD-10 Frequently Asked Questions for Providers

ICD-10 Frequently Asked Questions for Providers FAQ Sections: ICD-10 Claims Billing and Coding ICD-10 Testing ICD-10 Issues Resolution Processes ICD-10 Training and Resources ICD-10 Claims Billing and Coding Will you be ready to accept ICD-10 codes

More information

Smarter Healthcare Processes in 2010. Imagine if

Smarter Healthcare Processes in 2010. Imagine if Smarter Healthcare Processes in 2010 Imagine if Healthcare Revitalized Reduce Costs, Increase Productivity, Deliver Best Outcomes with IBM ILOG Business Rule Management System (BRMS) and Optimization Software

More information

OVERVIEW DATA SHEET. MedAct Overview Data Sheet

OVERVIEW DATA SHEET. MedAct Overview Data Sheet MedAct Overview Data Sheet MedAct delivers an integrated solution for your HME/DMEPOS that provides end-to-end coverage of all your business needs. From patient intake and purchasing to inventory management,

More information

Outperform Financial Objectives and Enable Regulatory Compliance

Outperform Financial Objectives and Enable Regulatory Compliance SAP Brief Analytics s from SAP SAP s for Enterprise Performance Management Objectives Outperform Financial Objectives and Enable Regulatory Compliance Drive better decisions and streamline the close-to-disclose

More information

ACS DOL. Electronic Submission Standard Changes. Provider Training X12N 5010

ACS DOL. Electronic Submission Standard Changes. Provider Training X12N 5010 ACS DOL Electronic Submission Standard Changes Provider Training X12N 5010 AGENDA Purpose Acronyms and Definitions What is an Electronic Submission? Electronic Submission Overview What s New? Submission

More information

ICD-10 Compliance Date

ICD-10 Compliance Date ICD-10 Implementation Frequently Asked Questions Updated September 2015 ICD-10 Compliance Date The U.S. Department of Health and Human Services (HHS) issued a rule on July 31, 2014 finalizing October 1,

More information

SAP Travel OnDemand Solution An Easier Way to Travel

SAP Travel OnDemand Solution An Easier Way to Travel SAP Brief SAP Travel OnDemand Objectives SAP Travel OnDemand An Easier Way to Travel Focus on your business while controlling travel costs Focus on your business while controlling travel costs With the

More information

Advent Software. Advent Software. Innovative Solutions for Investment Management

Advent Software. Advent Software. Innovative Solutions for Investment Management Advent Software Advent Software Innovative Solutions for Investment Management Innovation & Proven Reliability Since 1983 Setting the Standard for Investment Technology 25 Years of Innovation Advent pioneered

More information

Secure Data Transmission Solutions for the Management and Control of Big Data

Secure Data Transmission Solutions for the Management and Control of Big Data Secure Data Transmission Solutions for the Management and Control of Big Data Get the security and governance capabilities you need to solve Big Data challenges with Axway and CA Technologies. EXECUTIVE

More information

ORACLE HYPERION FINANCIAL DATA QUALITY MANAGEMENT

ORACLE HYPERION FINANCIAL DATA QUALITY MANAGEMENT Oracle Fusion editions of Oracle's Hyperion performance management products are currently available only on Microsoft Windows server platforms. The following is intended to outline our general product

More information

EMDEON PAYMENT INTEGRITY SERVICES

EMDEON PAYMENT INTEGRITY SERVICES EMDEON PAYMENT INTEGRITY SERVICES Emdeon Fraud Prevention Services Emdeon Fraud Investigative Services Emdeon Clinical Integrity for Claims Emdeon Third-Party Liability Analysis Simplifying the Business

More information

Health Plan Certification of Compliance with HIPAA Electronic Transaction Standards

Health Plan Certification of Compliance with HIPAA Electronic Transaction Standards Issue 1 2014 Health Plan Certification of Compliance with HIPAA Electronic Transaction Standards The Department of Health and Human Services ( HHS ) issued proposed regulations that will require a controlling

More information

Customer Lifecycle Management How Infogix Helps Enterprises Manage Opportunity and Risk throughout the Customer Lifecycle

Customer Lifecycle Management How Infogix Helps Enterprises Manage Opportunity and Risk throughout the Customer Lifecycle Customer Lifecycle Management How Infogix Helps Enterprises Manage Opportunity and Risk throughout the Customer Lifecycle Analytics can be a sustained competitive differentiator for any industry. Embedding

More information

THE ONE-CLICK WAY T O F I L E C L A I M S A N D E N C O U N T E R S

THE ONE-CLICK WAY T O F I L E C L A I M S A N D E N C O U N T E R S I N T R O D U C I N G THE ONE-CLICK WAY T O F I L E C L A I M S A N D E N C O U N T E R S why file claims and encounters electronically? The Benefits Can Quickly Add Up! * $1.50 Average Savings per Claim

More information

Electronic Billing, EFT and other EDI Initiatives for Workers Compensation

Electronic Billing, EFT and other EDI Initiatives for Workers Compensation Electronic Billing, EFT and other EDI Initiatives for Workers Compensation Presentation to North Carolina MGMA Workers Compensation Committee September 10, 2014 Don St. Jacques, SVP Business Development

More information

Emptoris Contract Management Solution for Healthcare Providers

Emptoris Contract Management Solution for Healthcare Providers Emptoris Contract Management Solution for Healthcare Providers An Emptoris White Paper Emptoris, an IBM Company www.emptoris.com CMS-HP-4/12 Emptoris Contract Management Solution for Healthcare Providers

More information

Lower business risk and increase IT productivity with trusted, managed and secured file transfer

Lower business risk and increase IT productivity with trusted, managed and secured file transfer Lower business risk and increase IT productivity with trusted, managed and secured file transfer Today s dynamic business environments and economic uncertainty mean organizations must work smarter to remain

More information

Molina Healthcare Post ICD 10 FAQ

Molina Healthcare Post ICD 10 FAQ Molina Healthcare Post ICD 10 FAQ On March 31, 2014, the Senate voted to approve a bill to delay the implementation of ICD-10-CM/ PCS by at least one year. President Obama signed the bill into law on April

More information

ASSET ARENA PROCESS MANAGEMENT. Frequently Asked Questions

ASSET ARENA PROCESS MANAGEMENT. Frequently Asked Questions ASSET ARENA PROCESS MANAGEMENT Frequently Asked Questions ASSET ARENA PROCESS MANAGEMENT: FREQUENTLY ASKED QUESTIONS The asset management and asset servicing industries are facing never before seen challenges.

More information

Optum Intelligent EDI. Achieve higher first-pass payment rates and help your organization get paid quickly and accurately.

Optum Intelligent EDI. Achieve higher first-pass payment rates and help your organization get paid quickly and accurately. Optum Intelligent EDI Achieve higher first-pass payment rates and help your organization get paid quickly and accurately. The new benchmark for EDI performance Health care has outgrown commoditized EDI,

More information

GE Healthcare. Electronic data interchange and proactive services for Centricity revenue cycle management customers

GE Healthcare. Electronic data interchange and proactive services for Centricity revenue cycle management customers GE Healthcare Electronic data interchange and proactive services for Centricity revenue cycle management customers Accelerate revenue perf Key features updates and other payer-specific adjustments are

More information

Emdeon Claims Provider Information Form *This form is to ensure accuracy in updating the appropriate account

Emdeon Claims Provider Information Form *This form is to ensure accuracy in updating the appropriate account PAYER ID: SUBMITTER ID: Emdeon Claims Provider Information Form *This form is to ensure accuracy in updating the appropriate account 1 Provider Organization Practice/ Facility Name Provider Name Tax ID

More information

ENTERPRISE MANAGEMENT AND SUPPORT IN THE INDUSTRIAL MACHINERY AND COMPONENTS INDUSTRY

ENTERPRISE MANAGEMENT AND SUPPORT IN THE INDUSTRIAL MACHINERY AND COMPONENTS INDUSTRY ENTERPRISE MANAGEMENT AND SUPPORT IN THE INDUSTRIAL MACHINERY AND COMPONENTS INDUSTRY The Industrial Machinery and Components Industry Manufacturers in the industrial machinery and components (IM&C) industry

More information

Solving Pricing Alignment in Healthcare

Solving Pricing Alignment in Healthcare Educational Paper Solving Pricing Alignment in Healthcare From Difficulty Comes Opportunity February 2014 Administrative costs along healthcare supply chains make up roughly 30 to 40 percent of healthcare

More information

STRATEGIC PARTNERSHIP

STRATEGIC PARTNERSHIP South Africa STRATEGIC PARTNERSHIP WHERE INNOVATION BEGINS A web-enabled, transparent, continuous innovative marketplace that enables more efficiencies and effectiveness for s whilst providing multi-insurer,

More information

Asentinel Telecom Expense Management (TEM)

Asentinel Telecom Expense Management (TEM) PRODUCT BRIEF: ASENTINEL TELECOM EXPENSE MANAGEMENT (TEM) Asentinel Telecom Expense Management (TEM) Asentinel 6.0 is a comprehensive global telecom expense management software solution encompassing the

More information

IBM Rational systems and software solutions for the medical device industry

IBM Rational systems and software solutions for the medical device industry IBM Software August 2011 IBM Rational systems and software solutions for the medical device industry Improve processes, manage IEC 61508 and IEC 62304 standards, develop quality products Highlights Manage

More information

Submitted via Federal erulemaking Portal

Submitted via Federal erulemaking Portal Response to Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for

More information

Preemptive security solutions for healthcare

Preemptive security solutions for healthcare Helping to secure critical healthcare infrastructure from internal and external IT threats, ensuring business continuity and supporting compliance requirements. Preemptive security solutions for healthcare

More information

Minimize Access Risk and Prevent Fraud With SAP Access Control

Minimize Access Risk and Prevent Fraud With SAP Access Control SAP Solution in Detail SAP Solutions for Governance, Risk, and Compliance SAP Access Control Minimize Access Risk and Prevent Fraud With SAP Access Control Table of Contents 3 Quick Facts 4 The Access

More information

ICD-10 Compliance Date. Frequently Asked Questions. ICD-10 Implementation Frequently Asked Questions Updated September 2014

ICD-10 Compliance Date. Frequently Asked Questions. ICD-10 Implementation Frequently Asked Questions Updated September 2014 ICD-10 Implementation Frequently Asked Questions Updated September 2014 ICD-10 Compliance Date The U.S. Department of Health and Human Services (HHS) issued a rule on July 31, 2014 finalizing October 1,

More information

Lexmark Enterprise Software. Transforming customer engagement

Lexmark Enterprise Software. Transforming customer engagement Lexmark Enterprise Software Transforming customer engagement Customer relationships are the lifeblood of your business Whether you serve businesses, consumers, patients, students or citizens, the quality

More information

Managing the Multi-Company Corporation

Managing the Multi-Company Corporation Managing the Multi-Company Corporation A White Paper for Today s Growing Businesses 1 Managing the Multi-Company Corporation Executive Summary Managing the books in any company is increasingly challenging

More information

Predictive Straight- Through Processing

Predictive Straight- Through Processing Predictive Straight- Through Processing 2 TABLE OF CONTENTS 1 Introduction...3 2 The Benefits of Solving the STP Problem...7 3 How Can TIBCO Help?...7 4 How TIBCO s Solution Works...9 5 Summary...11 6

More information

SOLUTION BRIEF: CA IT ASSET MANAGER. How can I reduce IT asset costs to address my organization s budget pressures?

SOLUTION BRIEF: CA IT ASSET MANAGER. How can I reduce IT asset costs to address my organization s budget pressures? SOLUTION BRIEF: CA IT ASSET MANAGER How can I reduce IT asset costs to address my organization s budget pressures? CA IT Asset Manager helps you optimize your IT investments and avoid overspending by enabling

More information

How to select a practice management system

How to select a practice management system How to select a practice management system New challenges and opportunities are impacting your practice today The physician practice environment is changing dramatically. The transition to ICD-10-CM and

More information

The Availity Health Information Network

The Availity Health Information Network The Availity Health Information Network Streamline your workflow Michele Terry 2013 Availity is an independent company providing a wide variety of online tools that allow providers to access real-time

More information

Contents. Edifecs Keys to A Risk-Balanced Approach for a Smooth Transition to ICD-10. Executive Summary... 2. Background... 2

Contents. Edifecs Keys to A Risk-Balanced Approach for a Smooth Transition to ICD-10. Executive Summary... 2. Background... 2 Edifecs Keys to A Risk-Balanced Approach for a Smooth Transition to ICD-10 WHITE PAPER Executive Summary... 2 Table of Contents Background... 2 Imperatives for a Successful ICD-10 Transition... 3 Understanding

More information

VIRTUAL CARDS: Healthcare s New Electronic Payment Revolution

VIRTUAL CARDS: Healthcare s New Electronic Payment Revolution VIRTUAL CARDS: Healthcare s New Electronic Payment Revolution Healthcare is truly an 800-pound gorilla. Accounting for approximately one-sixth of the entire U.S. economy, industry spending totals more

More information

Trusted Partners for. Revenue Cycle Solutions

Trusted Partners for. Revenue Cycle Solutions Trusted Partners for Revenue Cycle Solutions for over 25 years! 44 Stelton Road Suite 315 Piscataway, NJ 08854 1.800.682.5749 732.752.7052 Fax: 732.424.0084 Revenue Cycle Management Outsourcing Ensuring

More information

Transaction Modernization Solutions for Healthcare

Transaction Modernization Solutions for Healthcare 1 Transaction Modernization Solutions for Healthcare Transaction Modernization Solutions Prevent, identify, and correct errors before or when they occur Reduce time and resources for researching problems

More information

Year In Review. Volumes continue to accelerate; steady flow of new customers

Year In Review. Volumes continue to accelerate; steady flow of new customers Year In Review Dear Shareholder, We are pleased to present the 2008 Year in Review. ICSGlobal made good progress with its dual edged global medical banking strategy - the expanded deployment of the Thelma

More information

Partner Collaboration Blueprint for ICD-10 Transition

Partner Collaboration Blueprint for ICD-10 Transition Partner Collaboration Blueprint for ICD-10 Transition 1 ICD-10 Transition Framework ESTABLISH A COLLABORATIVE BUSINESS PROCESS TRANSITION PLATFORM FOR ICD-10 AND BEYOND Migrating to the ICD-10 coding system

More information

SCALABLE SYSTEMS LIFE SCIENCE & HEALTHCARE PRACTICES

SCALABLE SYSTEMS LIFE SCIENCE & HEALTHCARE PRACTICES SCALABLE SYSTEMS LIFE SCIENCE & HEALTHCARE PRACTICES Improve Your DNA Data, Numbers & Analytics IntelliPayer Scalable Systems IntelliPayer solution is a next generation healthcare payer solution framework

More information

Implement a unified approach to service quality management.

Implement a unified approach to service quality management. Service quality management solutions To support your business objectives Implement a unified approach to service quality management. Highlights Deliver high-quality software applications that meet functional

More information

Real Time Adjudication Business Process Model

Real Time Adjudication Business Process Model WEDI /X12 Joint Real Time Adjudication Business Process Modeling Workgroup Real Time Adjudication Business Process Model Version 1 January 19, 2010 The Data Interchange Standards Association 7600 Leesburg

More information

The Importance of Software Management: How Rationalizing Assets Creates Real Business Benefits

The Importance of Software Management: How Rationalizing Assets Creates Real Business Benefits The Importance of Software Management: How Rationalizing Assets Creates Real Business Benefits IT As a Strategic Business Driver As the world has become more connected and employee and customer demands

More information

RTE Strategies for Revenue Cycle Management

RTE Strategies for Revenue Cycle Management Tutorials, M. Davis Research Note 18 February 2003 RTE Strategies for Revenue Cycle Management By 2005, care delivery organizations will have to adopt realtime enterprise strategies to survive the continued

More information

Manageability with BPM

Manageability with BPM Manageability with BPM Presenter Names: Thierry Hendrickx / Chris den Hoedt 2008 IBM Corporation Agenda What is BPM Managing Internal controls with BPM IBM s Vision to BPM 1 Government leaders know what

More information

Enrollment Guide for Electronic Services

Enrollment Guide for Electronic Services Enrollment Guide for Electronic Services 2014 Kareo, Inc. Rev. 3/11 1 Table of Contents 1. Introduction...1 1.1 An Overview of the Kareo Enrollment Process... 1 2. Services Offered... 2 2.1 Electronic

More information

Kofax White Paper. Overcoming Challenges in Accounts Payable Automation. Executive Summary. Benefits of Accounts Payable Automation

Kofax White Paper. Overcoming Challenges in Accounts Payable Automation. Executive Summary. Benefits of Accounts Payable Automation Kofax White Paper Overcoming Challenges in Accounts Payable Automation Executive Summary Accounts payable automation presents unique challenges. It is characterized by large volumes of data, arriving in

More information

For over 25 years, OpenText Cloud Fax Services has. OpenText Cloud Fax Services. The Market Leader in Cloud Fax Technology

For over 25 years, OpenText Cloud Fax Services has. OpenText Cloud Fax Services. The Market Leader in Cloud Fax Technology OpenText Cloud Fax Services The Market Leader in Cloud Fax Technology For over 25 years, OpenText Cloud Fax Services has helped many companies go paperless with solutions that integrate with both email

More information

The Seven Elements of a Vendor Oversight Program

The Seven Elements of a Vendor Oversight Program The Seven Elements of a Oversight Program DST Health Solutions September 2014 The Seven Elements of a Oversight Program The Seven Elements of a Oversight Program Medicare Advantage plans must gain efficiencies

More information

Optum Health Payment Solutions

Optum Health Payment Solutions Optum Health Payment Solutions Today s competitive health care market demands that payers like you meet cost containment objectives and administrative simplification goals set out in the Affordable Care

More information

EMC CAPTIVA SOLUTIONS FOR HEALTHCARE

EMC CAPTIVA SOLUTIONS FOR HEALTHCARE EMC CAPTIVA SOLUTIONS FOR HEALTHCARE Major advances in medical technology within the last several years have led members of an aging population to significantly raise expectations for the quality of care

More information

uplevl Empower data. Improve business ef f iciency. Go Paperless with End-to-End Accounts Payable Automation: An Uplevl White Paper

uplevl Empower data. Improve business ef f iciency. Go Paperless with End-to-End Accounts Payable Automation: An Uplevl White Paper uplevl Empower data. Improve business ef f iciency. Go Paperless with End-to-End Accounts Payable Automation: An Uplevl White Paper Overwhelmed with piles of paper invoices, purchase orders and contracts?

More information

Healthcare Insurance Portability & Accountability Act (HIPAA)

Healthcare Insurance Portability & Accountability Act (HIPAA) O C T O B E R 2 0 1 3 Healthcare Insurance Portability & Accountability Act (HIPAA) Secure Messaging White Paper This white paper briefly details how HIPAA affects email security for healthcare organizations,

More information

AMBIT LOAN ORIGINATION A New Approach

AMBIT LOAN ORIGINATION A New Approach AMBIT LOAN ORIGINATION A New Approach Overview A key area of focus for many banks is loan origination; a part of banking still typified by fragmented, paper-based, largely manual activities, and characterized

More information

The need for optimization: Getting the most from Microsoft Dynamics GP

The need for optimization: Getting the most from Microsoft Dynamics GP The need for optimization: Getting the most from Microsoft Dynamics GP Prepared by: Hans Wulczyn, Director, RSM US LLP hans.wulczyn@rsmus.com, +1 717 901 8413 October 2013 Microsoft Dynamics GP is a powerful,

More information

ICD-10 Updates. Working with Anthem Subject Specific Webinar Series. Special Session

ICD-10 Updates. Working with Anthem Subject Specific Webinar Series. Special Session Working with Anthem Subject Specific Webinar Series Special Session ICD-10 Updates Access to Audio Portion of Conference: Dial-In Number: 877-497-8913 Conference Code: 1322819809# Please Mute Your Phone

More information

STERLING COMMERCE WHITE PAPER. Four Keys to Effectively Monitor and Control Secure File Transfer

STERLING COMMERCE WHITE PAPER. Four Keys to Effectively Monitor and Control Secure File Transfer STERLING COMMERCE WHITE PAPER Four Keys to Effectively Monitor and Control Secure File Transfer 2 As more information is digitized and more business data is considered critical, you re spending far more

More information

Driving workload automation across the enterprise

Driving workload automation across the enterprise IBM Software Thought Leadership White Paper October 2011 Driving workload automation across the enterprise Simplifying workload management in heterogeneous environments 2 Driving workload automation across

More information

Four Clues Your Organization Suffers from Inefficient Integration, ERP Integration Part 1

Four Clues Your Organization Suffers from Inefficient Integration, ERP Integration Part 1 Four Clues Your Organization Suffers from Inefficient Integration, ERP Integration Part 1 WHY ADOPT NEW ENTERPRISE APPLICATIONS? Depending on your legacy, industry, and strategy, you have different reasons

More information

Provide access control with innovative solutions from IBM.

Provide access control with innovative solutions from IBM. Security solutions To support your IT objectives Provide access control with innovative solutions from IBM. Highlights Help protect assets and information from unauthorized access and improve business

More information

Provider Revenue Cycle Management (RCM) and Proposed Solutions

Provider Revenue Cycle Management (RCM) and Proposed Solutions Provider Revenue Cycle Management (RCM) and Proposed Solutions By: Ranjana Maitra General Manager, Manufacturing & Healthcare Vertical Executive Summary It takes more than world-class service to be competitive

More information

Sybase Solutions for Healthcare Adapting to an Evolving Business and Regulatory Environment

Sybase Solutions for Healthcare Adapting to an Evolving Business and Regulatory Environment Sybase Solutions for Healthcare Adapting to an Evolving Business and Regulatory Environment OVERVIEW Sybase Solutions for Healthcare Adapting to an Evolving Business and Regulatory Environment Rising medical

More information

Communications and Connectivity

Communications and Connectivity Chapter V Communications and Connectivity Trading partners are responsible for the purchase of communication protocol packages and access support for the dial-up process to the Enterprise EDI Gateway/Clearinghouse.

More information